Targeting CD4 testing to a clinical subgroup of patients could limit unnecessary CD4 measurements, premature antiretroviral treatment and costs in Thyolo District, Malawi.

Hdl Handle:
http://hdl.handle.net/10144/18360
Title:
Targeting CD4 testing to a clinical subgroup of patients could limit unnecessary CD4 measurements, premature antiretroviral treatment and costs in Thyolo District, Malawi.
Authors:
Zachariah, R; Teck, R; Ascurra, O; Humblet, P; Harries, A D
Journal:
Transactions of the Royal Society of Tropical Medicine and Hygiene
Abstract:
Malawi offers antiretroviral treatment (ART) to all HIV-positive adults who are clinically classified as being in WHO clinical stage III or IV without 'universal' CD4 testing. This study was conducted among such adults attending a rural district hospital HIV/AIDS clinic (a) to determine the proportion who have CD4 counts >or=350 cells/microl, (b) to identify risk factors associated with such CD4 counts and (c) to assess the validity and predictive values of possible clinical markers for CD4 counts >or=350 cells/microl. A CD4 count >or=350 cells/microl was found in 36 (9%) of 401 individuals who are thus at risk of being placed prematurely on ART. A body mass index (BMI) >22 kg/m(2), the absence of an active WHO indicator disease at the time of presentation for ART, and a total lymphocyte count >1,200 cells/microl were significantly associated with such a CD4 count. The first two of these variables could serve as clinical markers for selecting subgroups of patients who should undergo CD4 testing. In a resource-limited district setting, assessing the BMI and checking for active opportunistic infections are routine clinical procedures that could be used to target CD4 measurements, thereby minimising unnecessary CD4 measurements, unnecessary (too early) treatment and costs.
Affiliation:
Médecins sans Frontières, Medical Department (Operational Research HIV-TB), Brussels Operational Center, 94 Rue Dupre, Brussels, Belgium. zachariah@internet.lu
Publisher:
Elsevier
Issue Date:
Jan-2006
URI:
http://hdl.handle.net/10144/18360
DOI:
10.1016/j.trstmh.2005.06.018
PubMed ID:
16202436
Additional Links:
http://www.sciencedirect.com/science/journal/00359203
Language:
en
ISSN:
0035-9203
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorZachariah, R-
dc.contributor.authorTeck, R-
dc.contributor.authorAscurra, O-
dc.contributor.authorHumblet, P-
dc.contributor.authorHarries, A D-
dc.date.accessioned2008-02-14T16:43:06Z-
dc.date.available2008-02-14T16:43:06Z-
dc.date.issued2006-01-
dc.identifier.citationTargeting CD4 testing to a clinical subgroup of patients could limit unnecessary CD4 measurements, premature antiretroviral treatment and costs in Thyolo District, Malawi. 2006, 100 (1):24-31 Trans. R. Soc. Trop. Med. Hyg.en
dc.identifier.issn0035-9203-
dc.identifier.pmid16202436-
dc.identifier.doi10.1016/j.trstmh.2005.06.018-
dc.identifier.urihttp://hdl.handle.net/10144/18360-
dc.description.abstractMalawi offers antiretroviral treatment (ART) to all HIV-positive adults who are clinically classified as being in WHO clinical stage III or IV without 'universal' CD4 testing. This study was conducted among such adults attending a rural district hospital HIV/AIDS clinic (a) to determine the proportion who have CD4 counts >or=350 cells/microl, (b) to identify risk factors associated with such CD4 counts and (c) to assess the validity and predictive values of possible clinical markers for CD4 counts >or=350 cells/microl. A CD4 count >or=350 cells/microl was found in 36 (9%) of 401 individuals who are thus at risk of being placed prematurely on ART. A body mass index (BMI) >22 kg/m(2), the absence of an active WHO indicator disease at the time of presentation for ART, and a total lymphocyte count >1,200 cells/microl were significantly associated with such a CD4 count. The first two of these variables could serve as clinical markers for selecting subgroups of patients who should undergo CD4 testing. In a resource-limited district setting, assessing the BMI and checking for active opportunistic infections are routine clinical procedures that could be used to target CD4 measurements, thereby minimising unnecessary CD4 measurements, unnecessary (too early) treatment and costs.en
dc.language.isoenen
dc.publisherElsevier-
dc.relation.urlhttp://www.sciencedirect.com/science/journal/00359203-
dc.rightsArchived on this site with the kind permission of Elsevier Ltd. and the Royal Society of Tropical Medicine and Hygiene, http://www.rstmh.org/transactions.aspen
dc.subject.meshAdolescenten
dc.subject.meshAdulten
dc.subject.meshAnti-Retroviral Agentsen
dc.subject.meshAntigens, CD4en
dc.subject.meshBody Mass Indexen
dc.subject.meshCD4 Lymphocyte Counten
dc.subject.meshCosts and Cost Analysisen
dc.subject.meshFemaleen
dc.subject.meshHIV Infectionsen
dc.subject.meshHIV Seropositivityen
dc.subject.meshHealth Services Misuseen
dc.subject.meshHumansen
dc.subject.meshMalawien
dc.subject.meshMaleen
dc.subject.meshMiddle Ageden
dc.subject.meshPredictive Value of Testsen
dc.subject.meshReproducibility of Resultsen
dc.subject.meshRisk Factorsen
dc.titleTargeting CD4 testing to a clinical subgroup of patients could limit unnecessary CD4 measurements, premature antiretroviral treatment and costs in Thyolo District, Malawi.en
dc.contributor.departmentMédecins sans Frontières, Medical Department (Operational Research HIV-TB), Brussels Operational Center, 94 Rue Dupre, Brussels, Belgium. zachariah@internet.luen
dc.identifier.journalTransactions of the Royal Society of Tropical Medicine and Hygieneen

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